A fictional 56-year-old presents with fever, severe headache, neck stiffness and increasing confusion over several hours.
Frame the danger first.
- Strongly suspect bacterial meningitis when fever, headache, neck stiffness and altered cognition occur together.
- The complete red-flag combination may be absent, particularly in older or immunocompromised adults.
- Meningitis and sepsis can coexist; assess for a non-blanching rash and systemic compromise.
Act, escalate, reassess.
- Escalate immediately, begin ABCDE assessment and use the current local meningitis and antimicrobial pathway.
- Obtain blood cultures and other essential tests promptly, but do not allow investigations to cause clinically significant delay to antibiotics.
- Decide whether lumbar puncture is currently safe and whether imaging is needed first using senior guidance.
- Use appropriate infection-control precautions and involve infection specialists and critical care as indicated.
Red flags that change pace.
- Rapidly falling consciousness, focal neurological signs, abnormal pupils or ongoing seizure
- Shock, purpuric rash or rapidly progressive systemic illness
- Immunocompromise, pregnancy or concern for raised intracranial pressure
What makes care less safe.
- Excluding meningitis because the full classical combination is absent
- Delaying antibiotics for imaging or lumbar puncture
- Performing lumbar puncture without reassessing contraindications and physiological stability
Say the concern plainly.
Suspected bacterial meningitis with symptoms [summary], consciousness [trend], rash/sepsis findings [summary] and neurological findings [summary]. Cultures, antibiotics and lumbar-puncture/imaging decisions are [status]. Immediate senior and infection input is required.